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Question: If I have a question about appealing a claim that has been denied due to an NCCI edit, which agency is most appropriate to contact for a resolution?

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Answer: Though it may seem confusing, if you have a question about a specific claim, even if related to NCCI, you should direct it to your assigned Medicare Administrative Contractor (MAC), not an NCCI contractor.

鈥淭he NCCI Contractor is able to address general questions and concerns about the NCCI program and edits. Claim-specific inquiries must be directed to the MAC because NCCI edits are implemented by the MACs as part of routine claim processing. This includes appeals of NCCI-related denials,鈥� the Centers for Medicare & Medicaid Services (CMS) says on its website.

Don鈥檛 forget: CMS developed and implemented NCCI to promote standardized 鈥� correct 鈥� coding of Medicare Part B claims. Its policies are based on coding conventions defined in the American Medical Association鈥檚 (AMA) CPT^庐 code book, as well as 鈥渘ational and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices,鈥� according to CMS.